Duration of treatment with inhaled corticosteroids in nonasthmatic eosinophilic bronchitis: a randomized open label trial

Wenzhi Zhan, Jiaman Tang, Xiaomei Chen, Fang Yi, Lina Han, Baojuan Liu, Wei Luo, Qiaoli Chen, Kefang Lai, Wenzhi Zhan, Jiaman Tang, Xiaomei Chen, Fang Yi, Lina Han, Baojuan Liu, Wei Luo, Qiaoli Chen, Kefang Lai

Abstract

Background: Nonasthmatic eosinophilic bronchitis (NAEB) responds well to inhaled corticosteroids (ICS), while recurrence is common after discontinuing treatment. There are no data available to show whether treatment duration of ICS in patients with NAEB is related to recurrence. We aim to evaluate the effect of different duration of treatment with ICS on relapse of NAEB.

Methods: A total of 101 patients with NAEB were recruited to the open label, randomized, parallel-group trial. Patients were randomized to receive 1-month, 2-month, or 4-month treatment with inhaled budesonide (200 μg, twice daily). Sputum induction, cough visual analogue scale (VAS), and cough symptom score (CSS) were conducted at baseline and after completion of treatment. The patients were followed up for 1 year after treatment. The primary outcome was the relapse rate of NAEB in 1 year.

Results: ICS significantly decreased cough VAS, CSS, and sputum eosinophilia among these groups. There were no statistically significant between-group differences in cough VAS, CSS scores, and sputum eosinophil counts at the end of treatment, and no significant between-group differences in those changes from baseline to post-treatment. Significantly, more participants in the 1-month treatment group experienced a recurring episode of NAEB than those in the 3-month treatment group (41.9% versus 12.0%, p = 0.0137) at 1-year follow-up. The 2-month treatment group showed a lower tendency, with a relapse rate of 20.0% (p = 0.0644).

Conclusions: Our results suggest that inhaled corticosteroids should be administrated for at least 2 months to reduce the relapse of NAEB.

Clinical trial registration: The study was registered on ClinicalTrials.gov (NCT02002715). The reviews of this paper are available via the supplemental material section.

Keywords: cough; inhaled corticosteroids; nonasthmatic eosinophilic bronchitis; relapse.

Conflict of interest statement

Conflict of interest statement: The authors declare that they have no competing interests

Figures

Figure 1.
Figure 1.
Trial profile. GER, gastroesophageal reflux; ICS, inhaled corticosteroids; OSA, obstructive sleep apnoea.
Figure 2.
Figure 2.
Changes in sputum eosinophil count from baseline to the end of treatment visit. (a) 1-month treatment group; (b) 2-month treatment group; (c) 4-month treatment group. Post refers to the end of treatment visit. Data at baseline and the end of treatment visit for individual patients are shown as squares or circles linked by straight lines.
Figure 3.
Figure 3.
Relapse rate of NAEB in 1 year. 1-M: 1-month treatment group; 2-M: 2-month treatment group; 4M: 4-month treatment group; NAEB, nonasthmatic eosinophilic bronchitis.

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